Project Summary/Abstract This application proposes a career development and research plan aimed to develop me, Karen Woo, MD, MS into an independent clinician/scientist specializing in vascular surgery outcomes research and comparative effectiveness research. I am a board-certified vascular surgeon with a clinical and research interest in dialysis vascular access. I have prior clinical research experience in the subject of dialysis fistula maturation, patency and management of complications. I have created a unique collaboration with the Schaeffer Center for Health Policy and Economics at the University of Southern California which has extensive experience with outcomes research and comparative effectiveness research and is especially well suited to serve as a training site. The career development plan will consist of advanced coursework in biostatistics, clinical trial design, multidisciplinary conferences and project-based learning. The proposal will be conducted under the direction of the mentorship committee. The primary mentor will be Dana Goldman, PhD, who holds the Leonard D. Schaeffer Director's Chair at the Schaeffer Center and is also Professor of Public Policy, Pharmacy and Economics in the Sol Price School of Public Policy and the School of Pharmacy. The advisory committee is comprised of Michael Allon, MD, Professor of Medicine at the University of Alabama, Robert J. Hye, MD, Chief of Vascular Surgery at Kaiser Permanente Hospital, San Diego, Clifford Y. Ko, MD, Professor of Surgery at UCLA and Peter F. Lawrence, MD, Professor of Surgery at UCLA. In the United States, the Fistula First Breakthrough Initiative, the National Kidney Foundation Dialysis Outcomes Quality Initiative Guidelines and the Center for Medicare Services End Stage Renal Disease Quality Incentive Program all encourage the creation of fistulas over grafts for hemodialysis vascular access. However, the elderly are the fastest growing segment of the end stage renal disease population and recently, evidence has emerged suggesting that fistulas may not provide the same benefits over grafts in the elderly population as in the younger population. The research described in this proposal utilizes outcomes research techniques to evaluate short term outcomes of fistulas vs grafts for dialysis vascular access in the elderly compared to non-elderly and determine factors which may aid in patient selection to optimize outcomes.